Hospital in Nghe An 'losing sleep' over fear of being discharged

(Baonghean) - In 2016, Nghe An Social Insurance did not accept payment of more than 115 billion VND, temporarily suspended more than 120 billion VND of health insurance examination and treatment costs of medical facilities in the province.This not only causes difficulties but also puts pressure on professional activities of the health sector.

Not suitable for medical practice

Thanh Chuong District General Hospital is a grade II hospital with 240 beds, providing medical examination and treatment for the people of the district and surrounding areas. On average, the hospital receives about 400 - 600 patients per day for examination and treatment in 16 clinical and paraclinical departments.

Doctor Nguyen Hai Linh - Director of the hospital said: "Some departments are too crowded with patients, others have few patients, leading to a local shortage of human resources. Departments with many patients lack doctors with practice certificates to meet the needs of medical examination and treatment. Doctors without practice certificates will be refused payment by health insurance if they examine. Currently, the hospital has 42 doctors, but only 30 have practice certificates."

Waiting area for medical examination at Nghe An Obstetrics and Pediatrics Hospital. Photo: PV

According to the Law on Medical Examination and Treatment and related circulars, doctors are only granted a practice certificate after 18 months of practice at a medical examination and treatment facility. Thus, the requirement to have a practice certificate to pay costs from Nghe An Social Insurance is "causing difficulties" for many hospitals in the province.

“It is already difficult for district hospitals to attract and recruit doctors. It takes nearly 2 years to recruit doctors to examine and treat patients, which is very inconvenient. If they do not allow examinations, there will be no human resources to serve the people. If they allow examinations, the Social Insurance will not pay. Doctors sent to study specialties and acquire new techniques do not have practice certificates, so after finishing their studies, they just leave them there. The requirements of the Social Insurance are probably only suitable for central or provincial hospitals that do not lack doctors,” said Dr. Nguyen Hai Linh.

Doctor Tran Van Cuong - Deputy Director of Nghe An Obstetrics and Pediatrics Hospital also shares the same opinion when he said that Nghe An Social Insurance Agency is being rigid in assessing and paying for medical examination and treatment costs. “Right now, the hospital’s facilities are just like that. When patients come, we cannot refuse, so the frequency of using machines is high, adding more beds outside the plan is inevitable. If we are rigid in following the Social Insurance’s request, we will transfer patients to other facilities, making the cost of examination and treatment even more expensive. A case of high fever and convulsions admitted to Nghe An Obstetrics and Pediatrics Hospital costs several million VND, but when transferred to the Central level, the cost increases to 20-30 million VND, but the result is that Nghe An Social Insurance still pays...”.

Doctor Dang Dinh Bang - Deputy Director of Nghe An Oncology Hospital said that the Social Insurance sector needs to clearly grasp the capacity as well as the actual situation of medical examination and treatment at medical facilities. “The hospital adding more beds is not wrong, because the Ministry of Health stipulates that patients cannot be placed in pairs or triples. Although our hospital is lacking, we still have to expand and build more houses for patients to be treated because there are always 750 - 800 patients, while the plan is only 530 beds. There are too many patients, doctors have to work overtime, that is true. Social Insurance should not be too rigid, it will cause frustration for doctors and nurses”.

Due to overload, Nghe An Oncology Hospital had to add more beds in the hallway. Photo: PV

Payment anxiety

At a recent meeting to discuss solutions to limit the excess of the health insurance fund organized by the People's Committee of Nghe An province, many leaders of medical facilities said that the measures to cut the health insurance fund expenditure of Nghe An Social Insurance were somewhat "extreme", focusing only on facilities with high medical examination and treatment costs to find ways to pay or suspend payments. As a result, instead of focusing on professional tasks, hospitals now have to spend time finding ways to "deal" with the Social Insurance.

One unit expressed indignantly: “For the whole year, we had to dedicate the hall to the inspection teams, while the hospital only cared about making explanations. This is a real waste of time and human resources, affecting the hospital’s main task of examining and treating patients to serve the people.” The fear of being released from the accounts makes hospitals “lose sleep” and lose their motivation to develop because “if they develop too much, they will be strictly inspected to be released from the accounts.”

Speaking at the meeting, Dr. Nguyen Hong Truong - Director of Vinh City General Hospital, the unit whose payment of more than 10 billion VND is currently suspended, said that the solutions that Nghe An Social Insurance has been applying only have immediate results and have not really touched the root of the problem. “The important thing is not to reduce spending, but to control spending properly. Here we need to distinguish between two concepts that are completely different in nature but similar in results: increased spending due to changes in policy mechanisms and overspending due to fund abuse. I completely agree with the Social Insurance making payments to cases showing signs of profiteering and falsification. As for any unit that is doing it right, the Social Insurance should share and create conditions for us to fulfill our mission of serving the people.”

Laparoscopic surgery at Thanh Chuong General Hospital

Doctor Dau Huy Hoan - Deputy Director of Nghe An Department of Health said: The open route creates conditions for people with health insurance cards to choose medical facilities for examination and treatment. This forces medical facilities to innovate their service style, improve service quality, update new techniques and equipment to increase competitiveness. However, this also leads to difficulties in paying health insurance due to inconsistent regulations between the health sector and social insurance. The social insurance suspending or refusing to pay for medical examination and treatment costs makes medical facilities frustrated and under pressure.

When the fear of payment is still hanging over our heads, it is certain that medical facilities will find it difficult to wholeheartedly serve patients, affecting the legitimate rights of health insurance participants, hindering the development of the health sector, and limiting the authority and responsibility of doctors as stipulated in the Law on Medical Examination and Treatment.

PV Group